The concerns and worries about the financial management of Southern Cross go back a long way. This is not ‘new’ news. The ‘new’ news is that the company is now close to the brink of collapse. There is almost an inevitability in this as those who sought to make a quick buck in the care sector realise that sometimes the figures don’t add up. Property doesn’t always pay. But making money on the back of what was a public monopoly (provision of care services) can lead to some rich pickings until some of that money needs to be spent. Corners are cut. Staff costs are cut. Older people are warehoused in increasingly larger residential and nursing homes while the roll-out of the so-called personalisation agenda rings very very hollow at the moment for those who are the most dependent and those who need long term care. Where this the personalisation within residential and nursing care services? Where are the small group homes with support for older adults with dementia? They don’t exist because they wouldn’t make a profit.

That is what those involved with personalisation need to address. Not how people who have capacity and ability to manage personal budgets or have families to help them will manage but how will personal budgets (health and social care) and personalisation help and create better systems for older adults in dementia nursing care. Give me an answer to these questions and I’ll have more faith.

So is this surprising? I wish it were. I want to emphasise though that it is the management of the CQC that I feel is badly serving those who need support and care rather than the individual inspectors who I know have as many criticisms of the system as the rest of us do. How did this, or the last government allow regulation so toothless just as they are ratcheting up the OFSTED inspections? Does it say anything about how we, as a society, want to value or hide away adults with disabilities? I suspect it does.

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3 thoughts on “CQC and Southern Cross – a retrospective”

Good roundup. You’ve been consistent in documenting your concerns about both organisations from a practitioners’ perspective and gosh, it turns out you were right all along.

With Southern Cross, it’s possible that this might be regarded as another organisation that’s ‘too big to fail’. It certainly wouldn’t be a good advertisement for handing over the support of vulnerable people to ‘any willing provider’ in the private sector if several thousand-odd vulnerable people were made homeless at a stroke.

The Welsh Assembly Government is currently striking a posture about refusing to bail out the company but has also and possibly with less fanfare instructed local authorities to draw up contingency plans in case of wide scale home closures. In view of the fact there are 34 Southern Cross Homes in Wales and that in some local authority areas they provide a high proportion of the available beds in some categories of care, I think the contingency plans of most authorities might read something like ‘hope for the best’ or ‘keep smiling’ since there would be no available capacity elsewhere in the system to accommodate large numbers of displaced residents.

There’s a lot of pressure on local authorities to pay more in care home fees to support a push to increase standards in the sector but I can’t see that being a popular option as an immediate solution here when everyone knows that any increase would go straight into the pockets of the homes’ landlords.

Some of Southern Cross’s landlords are in fact care home groups (evidently the ones who didn’t feel the need to sell off their properties to their rivals for reasons of capital efficiency) so if the worst happened, some of the homes might get taken over as going concerns by other organisations. Inevitably, some of the homes that were felt to be marginally profitable would close, awful for the residents and the staff involved but clearly, not as bad as the complete closure of the organisation.

I was once involved in the mad scrabbling around looking for alternative placements caused by the closure of a medium-sized private care home so know what sort of sweat and anxiety lies behind the bland phrase ‘contingency plan’. Anecdotally, I can testify that I saw some residents fade quickly when taken from familiar surroundings and I gather there are strongly supported actuarial figures that indicate that physically and cognitively frail people are more likely to die after a major upheaval.

Public authorities taking homes over as going concerns might therefore be preferable as an option so as to maintain relationships, rapport, knowledge about clients’ needs and preferences and what are in fact, communities but I doubt anyone would be considering this as anything more than a short-term expedient to manage a home’s eventual run-down and closure. Where local authorities have run down or entirely closed their own care homes, authorities would lack the skills and experience to manage care homes safely. There is I believe a legal impediment to local authorities running nursing registered homes that goes back to the 1948 National Assistance Act but some very swift legislation could ammend this but I suspect Health Boards and PCTs would be asked to consider taking some role in nursing homes.

Some of the fairly grim reports you’ve documented in your blog about problems in particular homes might discourage much criticised public bodies from seeking to inherit the difficulties in staffing and the quality of care stored up by Southern Cross’s niggardliness. Another possibility that might act as a deterrent to considering this solution is that the lawyers who’ve pursued class actions when local authority care homes have been run down or altered in the past but who have ignored turmoil in the private sector would instantly seek to put together cases as soon as public bodies stepped into any kind of managing role in a former Southern Cross Home.

I wonder if Mr Cameron would be brave enough to consider some of the homes as candidates for the sorts of ‘social enterprise’ he sometimes discusses and if he’d be prepared to lend out some of the top stream civil servants who were apparently to be made available to support various schemes in target areas to get things going? I’m prepared to bet that he wouldn’t because the consequences of any further failure or breakdown would then rebound on central government and after all, a care home and a mother and toddlers coffee morning are enterprises on slightly different scales.

I do wonder what sort of government pressure could be brought to bear on the landlords of the Southern Cross homes to revise their rent demands. Lots of other organisations with property based portfolios have taken big hits because of the state of the property market and I suppose it’s moderately disgusting that the residents of these care homes are being used as human shields or hostages to maintain rent revenues in this case.

Thanks for another fine contribution! I think the idea of social enterprises could be interesting but overall, I think both isses – the collapse of Southern Cross and the scaling back of regulation create real Cassandra-like prophecies for some of the govts plans for health reform. Hopefully more people will notice what we, in the care sector, have known for years.

BBC Radio 4 Today this morning had extensive discussion of this. As a matter of interest, what are the death rates of people being moved from one care home to another? I am probably biased, as this happened to my mum and…

I may have lost the plot somewhere, why precisely do not people in care homes have tenancy rights?

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